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ECMO-Extracorporeal Life Support in Adults pp 327–335Cite as

Heart-Beating and Non-Heart-Beating Donors

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Abstract

Organ transplantation is limited by the shortage of viable donor organs. Non-heart-beating donors (NHBD), also frequently referred to as donor after cardiac death (DCD), represent a promising source of grafts. Nevertheless, the initial period of warm ischemia can compromise the graft viability. Modified preservation techniques are crucial in stopping or reversing cellular injury, through cytoprotective mechanisms, allowing the recovery of a great portion of these grafts. Selective normothermic extracorporeal membrane oxygenation (NECMO) minimizes ischemic injury, playing a protective role on organ function preservation and maintaining tissue perfusion under controlled condition and temperature to restore metabolic processes. NECMO is believed to shift warm ischemic time toward ischemic preconditioning, providing greater viability for DCD donors. In the clinical setting, NECMO has been demonstrated to offer the possibility to obtain good quality grafts for transplant both in controlled and in uncontrolled DCD. Furthermore, in some countries ECMO has been used to support brain death (BD) multiorgan donors in case in which it is not possible to complete death assessment for cardiac or respiratory failure.

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Authors and Affiliations

  1. SC Anestesia e Rianimazione 1, Fondazione IRCCS Policlinico S. Matteo, V.le Golgi 19, Pavia, 27100, Italy

    Marinella Zanierato, Francesco Mojoli & Antonio Braschi

  2. Dipartimento di Scienze Clinico-chirurgiche, Diagnostiche e Pediatriche, Sezione di Anestesia Rianimazione e Terapia Antalgica, Università degli Studi di Pavia, V.le Golgi 19, Pavia, 27100, Italy

    Francesco Mojoli & Antonio Braschi

Authors
  1. Marinella Zanierato
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  2. Francesco Mojoli
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  3. Antonio Braschi
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Correspondence to Marinella Zanierato .

Editor information

Editors and Affiliations

  1. Department of Anaesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza (MB), Italy

    Fabio Sangalli

  2. Department of Health Sciences Medicine, University of Milano-Bicocca, San Gerardo Hospital, Monza (MB), Italy

    Nicolò Patroniti

  3. Health Science Departement, Università Milano Bicocca Facoltà Medicina e Chirurgia, Monza (MB), Italy

    Antonio Pesenti

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Zanierato, M., Mojoli, F., Braschi, A. (2014). Heart-Beating and Non-Heart-Beating Donors. In: Sangalli, F., Patroniti, N., Pesenti, A. (eds) ECMO-Extracorporeal Life Support in Adults. Springer, Milano. https://doi.org/10.1007/978-88-470-5427-1_28

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  • DOI: https://doi.org/10.1007/978-88-470-5427-1_28

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  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5426-4

  • Online ISBN: 978-88-470-5427-1

  • eBook Packages: MedicineMedicine (R0)

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